Dr. Goldstein believed ME/CFS was a disorder of disturbed central nervous system processing and developed a unique protocol for treating it.
He also wrote three books in the 1990's and in 2004: "Betrayal of the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Related Disorders" and "The Limbic Hypothesis" and Tuning the Brain".
Erica Verillo describes how he worked
He retired from practice in 2003.
Dr. Goldstein gave his "Resurrection Cocktail" to patients who had been bedridden for more than a year and for whom he would only see once. It apparently was a mix of the most potent drugs he had for ME/CFS.
The Resurrection Cocktail - A Deeper Look by ZZZ
(Thanks to ZZZ for allowing Health Rising to publish it)
To those of us who aren't even as sick as the patients he describes, such a "resurrection" sounds pretty miraculous. For the many people who experienced it, it felt like nothing short of a miracle, and the word "miracle" was frequently heard around Dr. Goldstein's office.
But what exactly did Dr. Goldstein use to perform his "resurrections"? Unfortunately, in typical Goldstein style, he doesn't go into any further details at this point. Nor is the word "resurrection" even mentioned in the rest of the book, or in any of his other books. At first glance, then, it would now appear that we are at a dead end.
However, Dr. Goldstein did write a description of these resurrections in an article he posted on his Web site, entitled “Tiptoe Through The Treatments: A Brief Guide To Some of What's New Since Betrayal by The Brain."
As the article's title implies, it was written between the publication of Betrayal by the Brain and Tuning the Brain. And although much of what is in the article is superseded by what was published in Tuning the Brain, there are various bits and pieces of information that appear in this article and nowhere else.
Dr. Goldstein's Web site disappeared shortly after his retirement in 2003. However, thanks to his dedicated followers, "Tiptoe Through The Treatments" can still be found in various places. Among the more reliable sources is Erica Verrillo's Web site. Erica Verrillo is probably best known at the author of Chronic Fatigue Syndrome: A Treatment Guide (2nd Edition), which is considered by many to be the best treatment guide currently available for ME/CFS.
"Tiptoe Through The Treatments" lists a number of drugs in alphabetical order that Dr. Goldstein started using after the publication of Betrayal by the Brain. Among them is ketamine. In the second half of the description of ketamine, there appears the complete list of ingredients for Dr. Goldstein's resurrection cocktail:
As is made clear in the text immediately preceding the quote above in Tuning the Brain, Dr. Goldstein always tried the naphazoline eyedrops first, as sometimes they made the resurrection cocktail unnecessary.
So at this point we have all the ingredients. It is also worth noting, in Dr. Goldstein's words, the power of some of the ingredients. For ketamine:
For IV lidocaine:
Now we have a list of all the ingredients in the resurrection cocktail. But what were the amounts of each, and how were they prepared? "Tiptoe Through The Treatments" is silent on these issues.
Back to Tuning the Brain. On page 369, in the section entitled "Lamotrigine" (which actually has only five sentences about lamotrigine), there is the following sentence:
And:
Now for the doses of the individual drugs. First, ketamine. On page 60 of Tuning the Brain:
On page 347:
Although Dr. Goldstein refers specifically to fibromyalgia here, he considers that all CFS patients with considerable muscle pain have fibromyalgia.
Dosing for ascorbic acid is described on page 132 of Betrayal by the Brain:
From the beginning of that paragraph:
In other words, the magnesium is actually optional, but the presence of ascorbic acid can cause it to be absorbed more effectively. In this environment, no more than one gram of magnesium should be used, and that much only in people who are known to tolerate magnesium well.
Now we have all the ingredients, but what about the fluid? According to Dr. Goldstein, all of these ingredients can be combined in one 500 ml bag. However, normal saline is recommended for ketamine and lidocaine, while half normal saline or Ringer's lactate is recommended for ascorbate, due to its high osmolality. In this case, the osmolality of the ascorbate is the controlling factor, and Dr. Goldstein would use half normal saline or Ringer's lactate for the combination. The infusion time should be three hours in order to avoid unwanted side effects.
For thyrotropin-releasing hormone, Dr. Goldstein used an intravenous injection of 500 mcg, as described on page 62 of Tuning the Brain. The dose of nimodipine (Nimotop) used is one 30 mg tablet, while the dose of gabapentin (Neurontin) used is 100 to 300 mg, typically in capsule form.
So now we have all the ingredients of the resurrection cocktail. Here they are, along with their doses, as used sequentially:
Once again, I would like to emphasize that this cocktail helped most of the very sickest bed bound ME/CFS patients get on their feet and walking in a matter of hours. And although there were a substantial minority who did not attain that level of recovery, it can be reasonably inferred that many of them had substantial improvements nonetheless.
This cocktail is not a cure, of course. It was used simply to get people to a high functioning level very quickly. To maintain that level, it was usually necessary to administer some of the regular treatments described in Betrayal by the Brain and Tuning the Brain.
The publication of this resurrection cocktail is intended to give people hope. For those people with this illness who are in dire straights (of whom there are far too many), this list can be taken to their doctors, along with the primary sources as well, if possible. Unfortunately, as Dr. Goldstein indicates, very few doctors would consider even the lidocaine portion of this cocktail, much less the whole thing. Great persistence would be needed in finding a doctor who would be willing to administer this cocktail. In any case, it is extremely important for reasons that Dr. Goldstein noted that the IV infusion be done over a period of a full three hours.
If ketamine is the only deal breaker in this cocktail, the formula should work almost as well without it.
Many (if not most) doctors would take one look at this formula and say, "This is crazy!" Such a verdict would not surprise Dr. Goldstein. Going back to the April 18, 1989 issue of The Los Angeles Times, entitled
And as my dear late grandmother would say, "So there you are."
He also wrote three books in the 1990's and in 2004: "Betrayal of the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome, and Related Disorders" and "The Limbic Hypothesis" and Tuning the Brain".
Erica Verillo describes how he worked
He retired from practice in 2003.
Dr. Goldstein gave his "Resurrection Cocktail" to patients who had been bedridden for more than a year and for whom he would only see once. It apparently was a mix of the most potent drugs he had for ME/CFS.
- Ketamine
- IV ascorbate
- IV lidocaine
- IV thyrotropin- releasing hormone (which raises all biogenic amines plus acetylcholine)
- Nimotop
- Neurontin (still the most effective oral agent but is being pushed by Tasmar)
The Resurrection Cocktail - A Deeper Look by ZZZ
(Thanks to ZZZ for allowing Health Rising to publish it)
From "Tuning the Brain" by Dr. Goldstein
But what exactly did Dr. Goldstein use to perform his "resurrections"? Unfortunately, in typical Goldstein style, he doesn't go into any further details at this point. Nor is the word "resurrection" even mentioned in the rest of the book, or in any of his other books. At first glance, then, it would now appear that we are at a dead end.
However, Dr. Goldstein did write a description of these resurrections in an article he posted on his Web site, entitled “Tiptoe Through The Treatments: A Brief Guide To Some of What's New Since Betrayal by The Brain."
As the article's title implies, it was written between the publication of Betrayal by the Brain and Tuning the Brain. And although much of what is in the article is superseded by what was published in Tuning the Brain, there are various bits and pieces of information that appear in this article and nowhere else.
Dr. Goldstein's Web site disappeared shortly after his retirement in 2003. However, thanks to his dedicated followers, "Tiptoe Through The Treatments" can still be found in various places. Among the more reliable sources is Erica Verrillo's Web site. Erica Verrillo is probably best known at the author of Chronic Fatigue Syndrome: A Treatment Guide (2nd Edition), which is considered by many to be the best treatment guide currently available for ME/CFS.
"Tiptoe Through The Treatments" lists a number of drugs in alphabetical order that Dr. Goldstein started using after the publication of Betrayal by the Brain. Among them is ketamine. In the second half of the description of ketamine, there appears the complete list of ingredients for Dr. Goldstein's resurrection cocktail:
So at this point we have all the ingredients. It is also worth noting, in Dr. Goldstein's words, the power of some of the ingredients. For ketamine:
Back to Tuning the Brain. On page 369, in the section entitled "Lamotrigine" (which actually has only five sentences about lamotrigine), there is the following sentence:
Lidocaine dosing is describe on page 46 of Betrayal by the Brain:
Dosing for ascorbic acid is described on page 132 of Betrayal by the Brain:
Now we have all the ingredients, but what about the fluid? According to Dr. Goldstein, all of these ingredients can be combined in one 500 ml bag. However, normal saline is recommended for ketamine and lidocaine, while half normal saline or Ringer's lactate is recommended for ascorbate, due to its high osmolality. In this case, the osmolality of the ascorbate is the controlling factor, and Dr. Goldstein would use half normal saline or Ringer's lactate for the combination. The infusion time should be three hours in order to avoid unwanted side effects.
For thyrotropin-releasing hormone, Dr. Goldstein used an intravenous injection of 500 mcg, as described on page 62 of Tuning the Brain. The dose of nimodipine (Nimotop) used is one 30 mg tablet, while the dose of gabapentin (Neurontin) used is 100 to 300 mg, typically in capsule form.
So now we have all the ingredients of the resurrection cocktail. Here they are, along with their doses, as used sequentially:
- Naphazoline eyedrops, 0.1% solution, one drop in each eye
- 500 ml of half normal saline or Ringer's lactate, administered over three hours, and containing the following:
- Ketamine in a dose of 25 to 100 mg
- Lidocaine in a dose of 200 to 300 mg
- Ascorbic acid in a dose of 25 to 50 grams
- Calcium gluconate in a dose of 500 mg
- (Optional) Magnesium in a dose of up to one gram
- Thyrotropin-releasing hormone (TRH) administered as an IV injection of 500 mcg
- Nimodipine in the form of one 30 mg tablet
- Gabapentin in a dose of 100 to 300 mg, typically in capsule form
Once again, I would like to emphasize that this cocktail helped most of the very sickest bed bound ME/CFS patients get on their feet and walking in a matter of hours. And although there were a substantial minority who did not attain that level of recovery, it can be reasonably inferred that many of them had substantial improvements nonetheless.
This cocktail is not a cure, of course. It was used simply to get people to a high functioning level very quickly. To maintain that level, it was usually necessary to administer some of the regular treatments described in Betrayal by the Brain and Tuning the Brain.
The publication of this resurrection cocktail is intended to give people hope. For those people with this illness who are in dire straights (of whom there are far too many), this list can be taken to their doctors, along with the primary sources as well, if possible. Unfortunately, as Dr. Goldstein indicates, very few doctors would consider even the lidocaine portion of this cocktail, much less the whole thing. Great persistence would be needed in finding a doctor who would be willing to administer this cocktail. In any case, it is extremely important for reasons that Dr. Goldstein noted that the IV infusion be done over a period of a full three hours.
If ketamine is the only deal breaker in this cocktail, the formula should work almost as well without it.
Many (if not most) doctors would take one look at this formula and say, "This is crazy!" Such a verdict would not surprise Dr. Goldstein. Going back to the April 18, 1989 issue of The Los Angeles Times, entitled
And as my dear late grandmother would say, "So there you are."
